Fillable CALIFORNIA STATE UNIVERSITY, CHICO REQUEST FOR TEMPORARY PAID (California State University, Chico)

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CALIFORNIA STATE UNIVERSITY, CHICO REQUEST FOR TEMPORARY PAID (California State University, Chico)

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Employee Name:
Employee ID:
Job Title:
Division/Department:
Classification:
Full-Time: Part-Time:
Exempt:
Non-Exempt:
Supervisor Name:
Supervisor email/Ext.
Date Requested:
Date of Requested Extension (if applicable):
REQUEST FOR TEMPORARY PAID ADMINISTRATIVE LEAVE (CPAL)
Coronavirus Pandemic (COVID-19)
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Date of Requested Extension (if applicable):
The CSU has implemented temporary paid leave program (CPAL) to ensure salary continuation for eligible employees. To access this
program, employees must complete and submit the signed request form to their campus Human Resources department prior to the
start of leave.
Coronavirus Paid Administrative Leave Program (CPAL): In accordance with HR Letter 2020-04, most employees (exempt and non-exempt)
including student employees are eligible to receive a one-time allotment of up to 32 days (256 hours) of paid administrative leave from March
23, 2020, through December 31, 2020, that can only be used due to COVID-19 related absences, subject to the following conditions:
• All hours must be used by close of business on December 31, 2020 at which time any remaining allotted hours will expire.
• The hours may be used at any time during this designated period including intermittently, in consultation with the appropriate
administrator, provided that such use shall not adversely affect the delivery of essential university services.
• The number of hours of paid administrative leave for employees who work less than full-time shall be prorated according to the
employee’s percent or timebase of their appointment.
PERMISSIBLE USE OF LEAVE
Select at
least One (1)
Qualifying Reasons to Use Coronavirus Pandemic (COVID-19) Temporary Paid Administrative Leave
I am unable to work due to my own COVID-19-related illness.
I am unable to work or work remotely due to my family member’s COVID-19 related illness. (For purposes of this
paid leave, family member includes those I would normally be able to use sick leave for.)
I am unable to work because I have been directed by my healthcare provider not to come to the worksite for
COVID-19-related reasons.
I am unable to work because I have been directed by my appropriate administrator not to come to the worksite
and it is not operationally feasible for me to work remotely.
I am unable to work due to a COVID-19-related school or daycare closure and I am required to be at home with a
child or dependent, and it is not operationally feasible for me to work remotely or in conjunction with the childcare
commitment.
CALIFORNIA STATE
UNIVERSITY, CHICO
HUMAN RESOURCES SERVICE CENTER
400 W. 1ST STREET
KENDALL HALL ROOM 220
CHICO, CA 95929-0010
530-898-6771
FAX: 530-898-5120
Page 1 of 3
TECHNICAL LETTER
HR/Leaves 2020-04
Attachment A
Request for Temporary Paid Administrative Leave (CPAL) | Rev. 7/13/2020
TECHNICAL LETTER
HR/Leaves 2020-04
Attachment A
400 W. 1ST STREET
KENDALL HALL ROOM 220
CHICO, CA 95929-0010
530-898-6771
FAX: 530-898-5120
CALIFORNIA STATE
UNIVERSITY, CHICO
HUMAN RESOURCES SERVICE CENTER
SIGNED AND AGREED BY:
To the best of my knowledge and belief, I certify that the facts stated within are accurate and in full compliance with CSU policies for CPAL
requirements. I understand I may be asked to substantiate the reason for the leave in accordance with current Bargaining Unit Contracts
and/or CSU Policies.
Request for Dates of Coronavirus Pandemic (COVID-19) Temporary Paid Administrative Leave
Total Hours
Month Dates Requested (Additional detail may be
attached to this form. Exempt employees must
use time in full day increments if not covered
under FML.)
Total Number
of Hours
Requested
Total Number
of Hours Used
Prior to this
Request
Total Number of
Hours Remaining
in Allotment
Employee Name:______________________________
Signature:______________________________ Date:____________
CAMPUS APPROVAL:
I approve the use of the temporary paid leave(s) as indicated above.
Appropriate Administrator Name: ____________________________ Signature: ________________________ Date: ________
HR/Academic Personnel Designee Name: _______________________ Signature: ________________________ Date: ________
Page 2 of 3
Request for Temporary Paid Administrative Leave (CPAL) | Rev. 7/13/2020
Request for Dates of CSU Temporary Leaves (CPAL) Detail by Month
___________________ Month:
_________________ Pay Period
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Month: ___________________
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Month: ___________________
Pay Period _________________
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400 W. 1ST STREET
KENDALL HALL ROOM 220
CHICO, CA 95929-0010
530-898-6771
FAX: 530-898-5120
CALIFORNIA STATE
UNIVERSITY, CHICO
HUMAN RESOURCES SERVICE CENTER
Page 3 of 3
Request for Temporary Paid Administrative Leave (CPAL) | Rev. 7/13/2020
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Completed 22 July 2020

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